BECOME A REACHER

Please COPY AND PASTE THE URL of a picture on your Facebook or Instagram page that best represents you on your best days. The photo can be from a recent social media #ChallengeAccepted or just a single photo that speaks to who you are on most days. *No filters necessary because I will not judge. Here is a sample url from http://bit.do/samplephoto

Link to A Photo From Your Social Media

Required

Characters Remaining: 500

About Your Social Media Pages
Which social media accounts are you actively on during the week? * Check all that apply. Your answers should reflect which social accounts you post to or use frequently.

Required

Instagram

Facebook

Tiktok

Twitter

YouTube

Clubhouse

Other

If other, type here

Optional

Characters Remaining: 500

Which of the follow options best describe how you currently use your social media pages? * Check all that apply. Your answers should reflect how you post, share, or interact with people on your platforms.

Required

As a business or fan page

To share pictures and/or stories with personal friends and families

To educate others about important social issues

I do not post on social media

Other

If other, type here

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Characters Remaining: 500

Your Experience with the Cause

Adverse Childhood Experiences are a PUBLIC HEALTH CRISIS & can be addressed TODAY!

Approximately, how long have you been following & studying ACE research?

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Brief description (or lengthy if you have time), but please share how you are currently using what you know about ACEs in your daily activities?

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What drew or moved you to the ACE research? Personal, Professional, other … Please elaborate a little (or a lot if you have time)

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Characters Remaining: 500

On a scale of 1-5, what is your comfort level with going LIVE on social media?

1 means, you are really camera shy. An answer of 5 means you can lead your own show if you had one.

*We need a variety of personalities, so please answer honestly as possible

Required

Are you currently or have you ever worked in Title 1 Public or Charter schools?

If YES, please use the OTHER option and list your current or past role in Title 1 school settings. Add as many details as the “OTHER” field will allow.

[Title I is a federally funded program for school districts that is designed to improve academic achievement of disadvantaged students]

Required

If other, type here

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Characters Remaining: 500

Are you licensed to practice anything in the field of Medicine, Therapy, or Health Care? Please list below.

If YES, please use the OTHER option and list the abbreviation or name of your licensure along with the state if it’s state specific.

Required

If other, type here

Optional

Characters Remaining: 500

Getting to know you better

Which of these ethnic categories would describe your natural heritage according to the census bureau? (Please use the OTHER option if none of the options match)

8.) Which of these ethnic categories would describe your natural heritage according to the census bureau? (Please use the OTHER option if none of the options match)

(Our goal is to establish trusting relationships with families and potential clients. We want to make sure that clients have an option to choose someone that they can relate to CULTURALLY AND SPIRITUALLY.)

Required

If other, type here

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Characters Remaining: 500

Please enter your city of residence. * (City only, you will select your state on the next question)

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Characters Remaining: 500

We are going to sweep the globe, so please select your state of residence.

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On a scale of 1-5, where are you on your spiritual journey?

An answer of 1 means, you are a brand-new follower, an answer of 5 means you can lead a clergy of men and women with your tongue and your actions if you wanted to.

We need a variety, so please answer honestly as possible.

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Is there anything else you'd like me to know about you?

Allow the spirit to move you if you elect to respond to this optional question.

Please list only what is on your HEART and not your RESUME.

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Characters Remaining: 500

Your Details

Additional Information For Your REACHER(s)

1 X BECOME A REACHER

Your Details

Additional Information For Your REACHER(s)

1 X BECOME A REACHER

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